In most situations, members must share in the cost of the service provided.
This is a Copayment (or copay), or a set amount members pay when they receive a service.
Please refer to your Member Handbook for complete information about copays.
You can find your copays on your member ID card.
Paying Copays and other Payments
- You must make copays directly to providers at the time of service.
- If you do not pay your copay, the provider and/or North Carolina Medicaid may use legal action to collect payment from you.
- You may be responsible for paying for non-covered services if you sign a release agreeing to pay before services are received. Note, the cost of non-covered services is likely to be more than a copay for a covered service.
These types of members are always exempt from copays:
- Native American
- Pregnant women
- Members receiving hospice care
Other Client Participation
The other type of cost sharing is when a member must pay a portion of their monthly expense. This is referred to as patient liability.
- These may include members in an institutional setting, or HCBS Waiver enrollees. Please refer to your Member Handbook for more information.